| Premier Shore Medical Llc | |
|
2621 Hwy 138 Wall Township NJ 07719-9660 | |
| (732) 556-1060 | |
| Not Available |
| Full Name | Premier Shore Medical Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2621 Hwy 138, Wall Township, New Jersey |
| Authorized Official Name and Position | Jason Nehmad (OWNER) |
| Authorized Official Contact | 9174068696 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Shore Medical Llc Po Box 101 W Long Branch NJ 07764-0101 Ph: () - | Premier Shore Medical Llc 2621 Hwy 138 Wall Township NJ 07719-9660 Ph: (732) 556-1060 |
| NPI Number | 1497229520 |
|---|---|
| Provider Enumeration Date | 01/11/2019 |
| Last Update Date | 01/11/2019 |
| Medicare PECOS PAC ID | 3173861606 |
|---|---|
| Medicare Enrollment ID | O20190208000233 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497229520 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jason A. Nehmad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780920645 PECOS PAC ID: 0648414706 Enrollment ID: I20130912000055 |
| Provider Name | Elyse Roddy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942725213 PECOS PAC ID: 8224302757 Enrollment ID: I20170922000911 |
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